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Chapter 12: Special Nutritional Considerations for Cardiovascular Health

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Chapter 12: Special Nutritional Considerations for Cardiovascular Health

20 problems · 0 figures

Case Study 12.1.1 §12.1 source ↗

Table 12.1 in the book ↗
Vital Signs Laboratory Results
Temperature: 37.4ºC

• Urine shows protein

• Liver enzymes are slightly elevated
Blood pressure: 224/200 mm Hg
Heart rate: 92 beats/min
Respiratory rate: 22 breaths/min
Oxygen saturation: 96% on room air

Read the following clinical scenario and then answer the questions that follow. This case study will evolve throughout the chapter.

Upon arrival at the labor and delivery department, Tara is placed on a fetal monitor, blood work and urine are collected, and her vital signs are obtained.

Tara is started on a labetalol drip for blood pressure control. The fetal monitor shows no distress to the fetus, so she is transferred to the intensive care unit for blood pressure monitoring and labetalol infusion.

Tara spends 4 days in the intensive care unit to get her blood pressure under control and to monitor her liver enzymes and kidney function. Her liver enzymes and kidney function normalize, and her blood pressure is now down to 120/76 mm Hg. She is converted to oral labetalol and will be ready to discharge home in the next day or two for a follow-up with the obstetrician within 3–4 days.

The nurse is providing nutritional education to Tara since she has a history of hypertension and developed pre-eclampsia. They both understand that nutrition and lifestyle modifications play a significant role in controlling blood pressure and helping prevent Tara’s blood pressure from spiking.

Which part of Tara’s assessment or history is concerning due to the possibility of complications during pregnancy?
  1. a.
    Respiratory rate of 22 per min
  2. b.
    Hypertension
  3. c.
    Heart rate of 92 beats per min
  4. d.
    Temperature of 37.4ºC

Answer

B. Hypertension
The client’s hypertension is concerning, because individuals who are already predisposed to high blood pressure before pregnancy are at an increased risk for having more complications during pregnancy due to the increase in vascular volume and increased stress on the body.

Case Study 12.1.2 §12.1 source ↗

Table 12.1 in the book ↗
Vital Signs Laboratory Results
Temperature: 37.4ºC

• Urine shows protein

• Liver enzymes are slightly elevated
Blood pressure: 224/200 mm Hg
Heart rate: 92 beats/min
Respiratory rate: 22 breaths/min
Oxygen saturation: 96% on room air

Read the following clinical scenario and then answer the questions that follow. This case study will evolve throughout the chapter.

Upon arrival at the labor and delivery department, Tara is placed on a fetal monitor, blood work and urine are collected, and her vital signs are obtained.

Tara is started on a labetalol drip for blood pressure control. The fetal monitor shows no distress to the fetus, so she is transferred to the intensive care unit for blood pressure monitoring and labetalol infusion.

Tara spends 4 days in the intensive care unit to get her blood pressure under control and to monitor her liver enzymes and kidney function. Her liver enzymes and kidney function normalize, and her blood pressure is now down to 120/76 mm Hg. She is converted to oral labetalol and will be ready to discharge home in the next day or two for a follow-up with the obstetrician within 3–4 days.

The nurse is providing nutritional education to Tara since she has a history of hypertension and developed pre-eclampsia. They both understand that nutrition and lifestyle modifications play a significant role in controlling blood pressure and helping prevent Tara’s blood pressure from spiking.

Tara asks about going out to dinner since she has a busy schedule. Which foods would be the best for her to choose for her diet?
  1. a.
    Fried chicken fingers and fries
  2. b.
    Well-grilled chicken salad with full-fat cheddar cheese and ranch dressing
  3. c.
    Raw sushi and rice
  4. d.
    Well-grilled steak and steamed broccoli

Answer

D. Well-grilled steak and steamed broccoli
Tara needs to avoid fried foods, undercooked foods, and foods high in fat. The steak is cooked properly and broccoli is a good source of nutrients.

Case Study 12.1.3 §12.1 source ↗

Read the following clinical scenario and then answer the questions that follow. This case study is a follow-up to Case Study Part A.

Tara is at an advanced maternal age. As an already busy mom and working full-time, she regularly has a very hectic schedule. Meals are often whatever she can pick up quickly. Tara has gained more weight in the second trimester than her obstetrician recommends; the doctor is concerned about her elevated blood pressure, cholesterol and glucose levels, heartburn, and lower leg edema.

Upon examination, fundal height is appropriate for gestation and fetal heart tones are normal. Considering Tara’s busy schedule and the three children she is already caring for, Tara is concerned about how to feed her family and keep herself healthy.

While preparing education for Tara, which information does the nurse need to include in the educational packet to help keep Tara and her fetus healthy?
  1. a.
    Decrease food intake
  2. b.
    Exercise 60 minutes daily
  3. c.
    Increase fruits and vegetables
  4. d.
    Increase salt in the diet

Answer

C. Increase fruits and vegetables
To help with heart health in both the client and fetus, the best answer choice is to increase fruits and vegetables.

Case Study 12.1.4 §12.1 source ↗

Read the following clinical scenario and then answer the questions that follow. This case study is a follow-up to Case Study Part A.

Tara is at an advanced maternal age. As an already busy mom and working full-time, she regularly has a very hectic schedule. Meals are often whatever she can pick up quickly. Tara has gained more weight in the second trimester than her obstetrician recommends; the doctor is concerned about her elevated blood pressure, cholesterol and glucose levels, heartburn, and lower leg edema.

Upon examination, fundal height is appropriate for gestation and fetal heart tones are normal. Considering Tara’s busy schedule and the three children she is already caring for, Tara is concerned about how to feed her family and keep herself healthy.

Which finding in Tara would be the most concerning for premature birth?
  1. a.
    Busy schedule
  2. b.
    High blood pressure
  3. c.
    Fundal height
  4. d.
    Pregnant with one fetus

Answer

B. High blood pressure
High blood pressure is associated with pre-eclampsia, which can cause premature birth.

Case Study 12.1.5 §12.1 source ↗

Read the following clinical scenario and then answer the questions that follow. This case study is a follow-up to Case Study Parts A and B.

Tara’s 3-year-old son, Carter, attends preschool Monday through Friday from 7 a.m. until 5:30 p.m. Other than several upper respiratory tract viral infections and several rounds of otitis media, Carter is relatively healthy. At his latest well-child visit, the health care provider was concerned with Carter’s high weight due to subsequent health issues related to childhood obesity.

When discussing a normal 24-hour diet for Carter, Tara shares that he typically eats breakfast, lunch, and a snack at preschool. They typically pick up food for dinner on the way home from work/preschool. As Tara often works from home on the weekends, she admits that Carter tends to get more screen time than she would like.

With Carter’s height charted at 36 inches and weight at 54 lb, calculate his BMI and indicate his BMI category. You may use this BMI calculator: https://www.cdc.gov/healthyweight/bmi/calculator.html.
  1. a.
    29.3; severe obesity
  2. b.
    19.2; healthy weight
  3. c.
    16.2; underweight
  4. d.
    32.2; severe obesity

Answer

A. 29.3; severe obesity
The client’s BMI places them in the severe obesity BMI category.

Case Study 12.1.6 §12.1 source ↗

Read the following clinical scenario and then answer the questions that follow. This case study is a follow-up to Case Study Parts A and B.

Tara’s 3-year-old son, Carter, attends preschool Monday through Friday from 7 a.m. until 5:30 p.m. Other than several upper respiratory tract viral infections and several rounds of otitis media, Carter is relatively healthy. At his latest well-child visit, the health care provider was concerned with Carter’s high weight due to subsequent health issues related to childhood obesity.

When discussing a normal 24-hour diet for Carter, Tara shares that he typically eats breakfast, lunch, and a snack at preschool. They typically pick up food for dinner on the way home from work/preschool. As Tara often works from home on the weekends, she admits that Carter tends to get more screen time than she would like.

While teaching Tara about healthy food choices for Carter, which statement is most appropriate?
  1. a.
    “Make sure Carter eats all of his food at each meal and that his plate is clean.”
  2. b.
    “Let Carter help you prepare meals in the kitchen while you are cooking.”
  3. c.
    “Since you are busy, Carter can have a cheeseburger and fries daily to help you.”
  4. d.
    “Screen time is good for Carter since you work and need to keep him occupied.”

Answer

B. “Let Carter help you prepare meals in the kitchen while you are cooking.”
To help encourage good food choices, involve children in preparing meals.

Case Study 12.1.7 §12.1 source ↗

Read the following clinical scenario and then answer the questions that follow. This case study is a follow-up from Case Study Parts A, B, and C.

Tara is a busy mother who typically does not like to cook. She does have 4 children ranging from ages 12 years to 2 weeks. While her husband’s parents help care for the children, it is typically Tara who cares for them daily. Tara’s husband is usually away on business 3–4 nights a week leaving Tara to care for the children herself.

At her last annual physical, her blood pressure was 148/84 mm Hg; total cholesterol was 248 mg/dL and triglycerides showed 173 mg/dL. Her health care provider discussed risk factors associated with cardiovascular disease.

Because school provides breakfast, lunch and a snack for Carter, Tara typically drinks several cups of coffee for breakfast, grabs lunch at work and picks up dinner on the way home from picking up her children from her in-law’s house. She works at home on the weekends, but believes she has time to make positive changes in their normal eating routine to include heart healthy meals.

Which would be the best choice for Tara to include in her dietary menu planning?
  1. a.
    Macaroni and cheese
  2. b.
    Fried chicken
  3. c.
    Pork sausage
  4. d.
    Apples

Answer

D. Apples
Apples would be the best choice, because the other options are high in fat and sodium.

Case Study 12.1.8 §12.1 source ↗

Read the following clinical scenario and then answer the questions that follow. This case study is a follow-up from Case Study Parts A, B, and C.

Tara is a busy mother who typically does not like to cook. She does have 4 children ranging from ages 12 years to 2 weeks. While her husband’s parents help care for the children, it is typically Tara who cares for them daily. Tara’s husband is usually away on business 3–4 nights a week leaving Tara to care for the children herself.

At her last annual physical, her blood pressure was 148/84 mm Hg; total cholesterol was 248 mg/dL and triglycerides showed 173 mg/dL. Her health care provider discussed risk factors associated with cardiovascular disease.

Because school provides breakfast, lunch and a snack for Carter, Tara typically drinks several cups of coffee for breakfast, grabs lunch at work and picks up dinner on the way home from picking up her children from her in-law’s house. She works at home on the weekends, but believes she has time to make positive changes in their normal eating routine to include heart healthy meals.

What are ways in which Tara could decrease her cholesterol instead of being placed on medication?
  1. a.
    Increase fiber in her diet
  2. b.
    Drink more sodas
  3. c.
    Increase intake of fatty meats
  4. d.
    Eat more processed foods

Answer

A. Increase fiber in her diet
Foods high in fiber can help lower cholesterol levels.

Case Study 12.3.9 §12.3 source ↗

Read the following clinical scenario and then answer the questions that follow. This case study is a follow-up from Case Study Parts A, B, C, and D.

Recently, Tara has noticed her legs are swelling and she has experienced some shortness of breath with activity, so she schedules an appointment with her primary care provider.

At Tara’s appointment, her provider takes her vital signs and finds her blood pressure is 165/85 mm Hg and her heart rate is 72 beats per minute. She is experiencing crackles in the base of her lungs and 2+ pitting edema to bilateral lower extremities.

The provider is concerned that Tara has developed heart failure and wants the nurse to educate Tara on healthy food choices. The provider places Tara on the diuretic furosemide to decrease Tara’s swelling and a potassium supplement. The provider orders laboratory work that includes a comprehensive metabolic panel and B-type natriuretic peptide.

The nurse is educating Tara on nutritional considerations related to her condition. Which education statement would be appropriate for the nurse to tell Tara?
  1. a.
    “You need to increase your intake of potassium-rich foods.”
  2. b.
    “You need to increase the amount of sodium in your diet.”
  3. c.
    “You need to identify a small list of foods that you can easily prepare and eat several times a week.”
  4. d.
    “You may need a vitamin supplement if you are unable to eat a variety of foods.”

Answer

D. “You may need a vitamin supplement if you are unable to eat a variety of foods.”
The client is taking furosemide, which is a diuretic. Diuretics increase the risk for water-soluble vitamin deficiencies particularly if the client is not able to eat a varied, nutrient-rich diet.

Case Study 12.3.10 §12.3 source ↗

Read the following clinical scenario and then answer the questions that follow. This case study is a follow-up from Case Study Parts A, B, C, and D.

Recently, Tara has noticed her legs are swelling and she has experienced some shortness of breath with activity, so she schedules an appointment with her primary care provider.

At Tara’s appointment, her provider takes her vital signs and finds her blood pressure is 165/85 mm Hg and her heart rate is 72 beats per minute. She is experiencing crackles in the base of her lungs and 2+ pitting edema to bilateral lower extremities.

The provider is concerned that Tara has developed heart failure and wants the nurse to educate Tara on healthy food choices. The provider places Tara on the diuretic furosemide to decrease Tara’s swelling and a potassium supplement. The provider orders laboratory work that includes a comprehensive metabolic panel and B-type natriuretic peptide.

The nurse is giving Tara an example of a healthy meal for her heart. Which meal would be the most appropriate for the nurse to share with Tara?
  1. a.
    Fried chicken, green beans, and tea
  2. b.
    Grilled fish, steamed vegetables, and water
  3. c.
    Hamburger, chips, and water
  4. d.
    Baked chicken, rice, and white roll

Answer

B. Grilled fish, steamed vegetables, and water
The choice for a healthy heart diet is to choose grilled or baked protein with vegetables and low to no sugar substances.

12-1 §12.RQ source ↗

A client who has a pre-existing heart condition consults her provider to plan for her next pregnancy. Which statement would the provider need to include in the teaching for a client who has a normal BMI?
  1. a.
    “You are able to gain as much weight as you need.”
  2. b.
    “You need to increase your caloric intake by 340 calories daily in the second trimester.”
  3. c.
    “You need to drink whole milk to help the fetus’s bones develop.”
  4. d.
    “You need to refrain from exercising.”

Answer

B. “You need to increase your caloric intake by 340 calories daily in the second trimester.”
The pregnant client who has a pre-existing heart condition will need to increase calories by 340 calories daily to gain the necessary amount of weight but not an excessive amount that can strain their cardiovascular system.

12-2 §12.RQ source ↗

When educating a new client about nutrition for their child to promote heart health, which statement should be included?
  1. a.
    “Use only breast milk for the first 6 months of life.”
  2. b.
    “At six months, pureed vegetables can be added to the infant’s diet.”
  3. c.
    “You can give your infant 100% fruit juice.”
  4. d.
    “Healthy eating habits cannot start until later.”

Answer

B. “At six months, pureed vegetables can be added to the infant’s diet.”
Infants can be introduced to pureed fruits and vegetables and infant cereals at 6 months.

12-3 §12.RQ source ↗

When teaching a client about healthy snack choices for their child to promote heart health, which snack choice would be the most appropriate?
  1. a.
    Fruit flavored snacks
  2. b.
    Whole milk
  3. c.
    Banana
  4. d.
    Ice cream

Answer

C. Banana
The banana is the best choice for the snack as it is low in fat and sugar.

12-4 §12.RQ source ↗

For a client who is following a heart healthy diet, what is the recommended sodium intake?
  1. a.
    < 1500 mg/day
  2. b.
    < 2300 mg/day
  3. c.
    < 3000 mg/day
  4. d.
    < 4000 g/day

Answer

B. < 2300 mg/day
Adults should strive for an intake of less than 2300 mg of sodium daily.

12-5 §12.RQ source ↗

Which factor can influence teenagers’ nutritional intake but may not have as strong an influence in other age groups?
  1. a.
    Social media
  2. b.
    Parental guidance
  3. c.
    Income level
  4. d.
    Availability of food

Answer

A. Social media
Social media and peers can strongly influence adolescent eating habits.

12-6 §12.RQ source ↗

A teenager comes to the clinic with her parents for concerns about eating disorders. Which long-term complication is associated with eating disorders?
  1. a.
    Aortic stenosis
  2. b.
    Diverticulitis
  3. c.
    Hypokalemia and hyponatremia
  4. d.
    Rheumatoid arthritis

Answer

C. Hypokalemia and hyponatremia
Long-term complications of eating disorders cause electrolyte imbalances, prolong QT intervals, which can cause arrhythmias, and can eventually lead to heart failure due to the stress on the heart.

12-7 §12.RQ source ↗

A nurse is providing education to a client with a total cholesterol of 240 mg/dL. Which of the following diet strategies needs to be included?
  1. a.
    Continue to consume 5–7 alcoholic beverages each week
  2. b.
    Decrease intake of red meat and full-fat dairy products
  3. c.
    Decrease intake of oatmeal, lentils, and other sources of fiber
  4. d.
    Continue the current diet plan— this cholesterol level is within the accepted range

Answer

B. Decrease intake of red meat and full-fat dairy products
Red meat and full-fat dairy products can elevate cholesterol levels.

12-8 §12.RQ source ↗

Which of the following would be an example of a DASH diet meal?
  1. a.
    Sliced ham, canned corn, and a cup of milk
  2. b.
    Fried eggs, bacon, and coffee
  3. c.
    Grilled shrimp with whole grain rice and mixed vegetables
  4. d.
    Oatmeal, sausage, and apple juice

Answer

C. Grilled shrimp with whole grain rice and mixed vegetables
Shrimp is a lean source of protein, whole grain rice is a complex carbohydrate, and vegetables are an excellent source of nutrients.

12-9 §12.RQ source ↗

A client is taking warfarin for a valve replacement. Which food should the nurse include in the teaching that the client should consistently consume?
  1. a.
    Asparagus
  2. b.
    Potatoes
  3. c.
    Water
  4. d.
    Protein

Answer

A. Asparagus
Clients who are taking warfarin should be instructed to have a consistent intake of leafy green vegetables, which can affect the clotting factors associated with the warfarin.

12-10 §12.RQ source ↗

The nurse is educating a client on how to eat heart healthy. The client tells the nurse that their typical meal consists of traditional Mexican foods. Which meal chosen would indicate the client understands the instruction?
  1. a.
    Beef enchilada with cheese sauce and refried beans
  2. b.
    Nachos covered with grilled chicken, cheese, sour cream, and lettuce
  3. c.
    Quesadilla with fried shrimp, black beans, and pico de gallo
  4. d.
    Grilled chicken, onions, green peppers, and avocado with corn tortillas

Answer

D. Grilled chicken, onions, green peppers, and avocado with corn tortillas
A meal of grilled chicken, onions, green peppers, and avocado with corn tortillas is lower in fat than the other choices.

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Problems and answers are adapted from Nutrition for Nurses by Emerald Charity Bilbrew, Jody Vogelzang and Kelli Whittington, OpenStax, and are used under the CC BY-NC-SA 4.0 licence. Access for free at https://openstax.org/books/nutrition/pages/1-introduction. Illustrations: Copyright Rice University, OpenStax, under CC BY-NC-SA 4.0 license. This adaptation is released under the same licence, is non-commercial, and is neither affiliated with nor endorsed by OpenStax or Rice University.